Sick days are rough for a parent, especially if you have to miss work to take care of a sniffling kid. Check out this list of simple activities to make the most of your day together.

Sick days are rough for a parent, especially if you have to miss work to take care of a sniffling kid. Check out this list of simple activities to make the most of your day together.

By Madonna Behen

Finding the right day-care center requires a balance of many practical issues: location, cost, hours of operation. And you of course also want a nurturing staff. "But bottom line, your child's health and safety is what matters the most," says Patricia Skinner, executive director of the Capital District Child Care Council, a resource and referral agency serving six counties in the Albany, N.Y., region. "After all, it doesn't matter how stellar the caregiver's interactions are if there's broken glass on the playground," she says.

Narrow down your choices and find a safe day care for your child by considering these four questions:

1. Is the center licensed (or registered)?

Most states require day-care centers to comply with minimum health and safety standards, so your first step is to find out if the facility you're considering is state-approved. In New York State, for instance, freestanding child-care centers must be licensed, while those that operate out of a home must be registered. If you opt for an in-home caregiver who looks after one or two kids, many states exempt these individuals from registration or licensing. However, some states do require in-home caregivers to complete a criminal-history check or child abuse/neglect screening; others require basic health and safety training. For more information, visit www.childcareaware.org.

2. Is the environment safe, both indoors and out?

Always take a tour of the facility when children are there to look for potential hazards, like heavy objects that kids could pull down on top of themselves. "It's great to get references, but there's really no substitute for your own observations," says Skinner. "You learn so much more when you spend time in a center and observe." Pay particular attention to the playground and other outside areas, which is where most day-care injuries occur. Make sure that kids are never left unattended -- even if they're sleeping. Also ask about the staff-to-child ratio. The younger your child is, the lower the ratio should be. For instance, one family-home caregiver should take care of only two infants. But 4-year-olds do well with a ratio of 1-to-10 (one adult for 10 children).

3. Does the staff follow proper infection-control procedures?

Do staffers wash their hands after each diaper change? Is the food-preparation area clean and orderly? How often are the communal toys disinfected? (Toys should be disinfected on a daily basis or more often if they're visibly soiled.) You should also ask if children wash their hands before eating and after using the bathroom, since kids are exposed to most germs by touching surfaces and then putting their fingers in their mouths. Ask caregivers all these questions, but also observe to see if the staff is really doing what they say they do.

4. What are the policies regarding sick children?

Child-care providers should have specific criteria outlining when to send a sick child home, and it's good to know the particulars so you can decide what requirements are important to you. Many centers follow national health and safety guidelines developed by the American Academy of Pediatrics and the American Public Health Association (APHA), but some are more stringent.

An example: AAP/APHA guidelines state that a child with a fever (defined as an oral temperature above 101 F, a rectal temperature above 102 F or an armpit temperature above 100 F) who is otherwise acting normally shouldn't be excluded from child care. However, many centers use fever alone as a reason to send a child home. "The providers can set their own exclusion criteria, and some of them are more restrictive than the guidelines," says Jean Wiseman, a registered nurse and child-care health consultant at the Capital District Child Care Council. "That's partly because they've seen what can happen when an illness that's not treated properly runs through every child in the program and all the staff too." So if you worry that a day-care center's stringent rules may one day exclude your child from care when you need it most, it's likely in everyone's best interest that sick kids don't mix with healthy ones.

What to Do if Your Child Is Sick

It's the scenario every working mother dreads: Your 3-year-old wakes up coughing, sneezing and clearly out of sorts; your husband is out of town on business; you're due at the office in three hours for an important meeting. When your little one is too sick to go to his regular day care -- but not sick enough to for you to justify rescheduling your meeting and using up yet another dwindling vacation day, you may have more options than you realize. Some hospital child-care facilities operate day-care programs for mildly ill children that are open to everyone in the community. In addition, some freestanding child-care centers offer separate infirmaries for sick kids. For more information about child-care options for sick children, visit the National Association for Sick Child Daycare at www.nascd.com.

Madonna Behen writes about women's and children's health for many acclaimed national magazines, including Woman's Day, Women's Health and Real Simple. A mother of three, she was health director of Woman's Day for a decade.

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